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General NPI Number Information
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NPI Number | 1922065564
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Entity Type | Individual
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Provider Name | AUDREY ELAINE SEATON-BACON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 1338 CENTER COURT DR STE 102
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City | COVINA
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State | CA
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Zip | 91724-3681
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Country | US
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Telephone | 562-907-9196
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Fax | 562-479-0365
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Provider Business Mailing Address
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Address Line | PO BOX 585
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City | PARK HILLS
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State | MO
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Zip | 63601-0585
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Country | US
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Telephone | 562-907-9196
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Fax | 562-479-0365
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY16171
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License Number State | CA
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